2022 AMI Online Salon

Hepatic Artery Aneurysm Repair

Project Details

  • Entrant Name:  Tina Wang
  • Client: Lydia Gregg
  • Copyright:  Ting Wang, 2021
  • Medium/software used: Adobe Photoshop
  • Final presentation format: Presentation slide
  • Primary Audience: Surgeons

Project Description

Hepatic artery aneurysms (HAAs) are a rare vascular disorder, but clinically important due to high rate of rupture resulting in high mortality. In this case study, the patient was presented with a large HAA that spanned both common hepatic artery (CHA) and hepatic artery proper (HAP). This surgical illustration depicts the HAA repair surgery performed by suturing a Dacron graft to the hepatic artery bifurcation and the celiac trunk. The aneurysm sac is then reapproximated, encasing the graft. Two suture patterns are depicted:  interrupted and running. The central main image shows how the needle enters and exits the vessel wall, the tying of the interrupted sutures, and the finished appearance. A bright spotlight directs the viewer’s attention to the aneurysm sac. Surrounding anatomy is dimmed and blurred to eliminate distraction. At both ends of the aneurysm sac, running sutures anastomose the graft to healthy arterial tissue. Further details are shown in the 2 insets:  inset A depicts the beginning (back of the vessel wall) and inset B the completion (front wall) of the running pattern, performed using a double-armed needle. Celiac trunk and splenic artery are shown clamped during the suturing. Sutures are color-coded using a colorblind accessible palette. The insets are placed alongside the corresponding finished appearance in the main image and maintain the same orientation for clarity. Altered upper GI anatomy is depicted; the patient had prior abdominal surgery.